On August 27, after nearly a month on the DL with ankle peroneal
tendonitis, Red Sox catcher Ryan Hanigan began a rehabilitation assignment
with Double-A Portland. It’s good news heading into September — the time of
year championship-caliber teams start to get healthy and go on a run. But
what exactly is peroneal tendonitis and what can you learn from Hanigan’s
injury? Joseph DeAngelis, MD, Orthopedic Surgeon in the Division of Sports
Medicine and Shoulder Surgery at Beth Israel Deaconess Medical Center, says
this somewhat rare but aggravating injury can frustrate even the most
dedicated athletes.

“Peroneal tendonitis is a frustrating injury because the peroneal tendons
play an important role in athletics and every-day mobility,” says
DeAngelis. “They support the outside of the ankle and give your foot power
and stability when you push off. When they’re inflamed, every step hurts.”

DeAngelis adds that other symptoms of peroneal tendonitis include:

An aching pain on the outside of the ankle that decreases with rest.

Swelling or soreness behind the ankle bone on the outside of the ankle.

Pain and weakness when actively moving the foot in an outward
direction, stretching the foot inward or when pointing it down.

Pain when pushing off the ball of the foot during walking, running or
when walking on irregular surfaces that turn the foot outward.

Although peroneal tendinitis is less common than other forms of tendon
pain, it can sometimes be more challenging for athletes to deal with. Even
just pinpointing the exact source of the pain can be difficult. That’s
because you actually have two peroneal tendons: the peroneus longus and the
peroneus brevis. The two run parallel to each other, connecting the outside
of your foot to the muscles in your lower leg. These tendons work together
to help stabilize your ankle and to help roll your foot outwards. In other
words, these tendons are a key part to being able to walk and run.

Says DeAngelis: “Athletes rely on their tendons to transmit force from the
muscles to the bones. With overuse, the tendons can become inflamed. As you
can imagine, you won’t be able to perform at a high level until that pain
and inflammation are gone.”

The best treatment for peroneal tendonitis is rest, regular stretching and
strength and balance exercises
to restore regular functioning of the tendon. It can also help to work with
a physical therapist to create a progressive treatment plan that is
targeted to your specific needs.

What you do at home can improve your recovery, too. “Rest and ice help to
relieve the pain and inflammation,” says DeAngelis. “In the end,
rehabilitation is about making sure an injury doesn’t come back. With
stretching and strengthening, you are setting the stage for a better,
healthy future.”

The Red Sox are hoping for a healthy future too. And with summer winding
down and the playoff race heating up, the timing couldn’t be better.